Provider Demographics
NPI:1194436949
Name:SOETERS, JESSICA LYNNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:SOETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 HILLSBORO PIKE APT 23E
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3726
Mailing Address - Country:US
Mailing Address - Phone:616-848-0889
Mailing Address - Fax:
Practice Address - Street 1:5025 HILLSBORO PIKE APT 23E
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3726
Practice Address - Country:US
Practice Address - Phone:616-848-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health